PNEUMONIA

I. Introduction

Pneumonia is an inflammation of
the lung parenchyma caused by
various microorganism Including
bacteria, mycobacteria, fungi, and
viruses.
II. Over view of the Disease
• Pneumonia is a form of acute respiratory
infection that affects the lungs. The lungs
are made up of small sacs called alveoli,
which fill with air when a healthy person
breathes. When an individual has
pneumonia, the alveoli are filled with pus
and fluid, which makes breathing painful
and limits oxygen intake.
 Symptoms
Typical signs and clinical manifestation of pneumonia are:
• High fever and chills
• Physical weakness and a strong feeling that you are unwell
• Cough with phlegm (sputum)
• Dyspnea/shortness of breath accompanied by tachypnea
• Rapid, bounding pulse
• Orthopnea, difficulty breathing while in supine position
• Poor appetite, diaphoresis/sweating
• Diarrhea
• Bluish skin, lips or nails (cyanosis).
• Confusion or altered mental state.
Causes/ Causative agents
Pneumonia is caused by several infectious agents, including viruses, bacteria and
fungi.
Causes/ Causative agents:
Pneumonia is caused by several infectious agents, including viruses, bacteria and
fungi.
A)Bacterial:-
• Pneumococcal pneumonia caused by Streptococcus pneumoniae is the most
common cause of bacterial pneumonia in children.
• Staphylococcal pneumonia caused by Staphylococcus aereus.
• Influenzal pneumonia caused by Haemophilus influenzae type b (Hib) is the
second most common cause of bacterial pneumonia.
• Gram negative bacterial pneumonia caused by Klebsiella pneumonia.
• Anaerobic bacterial pneumonia caused by normal oral flora.
• Mycoplasma pneumoniae
• Chlamydia pneumoniae
• Legionella
B) Viral:-
●Rhinovirus, coronavirus, influenza virus, respiratory
syncytial virus(RSV), Adenovirus and parainfluenza.
●Herpes simplex virus rarely causes pneumonia in
newborns, persons with cancer, transplant recipients,
and people with significant burns.
● People following organ transplantation or
immunocompromised present high rates of
cytomegalovirus pneumonia.
C) Fungal:-
●Fungal pneumonia caused by Histoplasmosis,
blastomycosis, coccidioidomycosis, aspergillosis, candidiasis

D) Parasitic:-
•Parasitic pneumonia caused by protozoa, nematodes,
platyhelminthes ; common organism is Pneumocystis (carinii)
jirovecci.
Transmission

Pneumonia can be spread in several ways. The

viruses and bacteria that are commonly found in a
child's nose or throat can infect the lungs if they are
inhaled. They may also spread via air-borne
droplets from a cough or sneeze. In addition,
pneumonia may spread through blood, especially
during and shortly after birth.
Classification of Pneumonia according to Environment.
●Commmunity Acquired Pneumonia
Occurs either in the community setting or within the first 48
hours after hospitalization or institutionalization.

●Hospital Acquired Pneumonia

Also known as nasocomial pneumonia, is defined as the onset
of pneumonia symptoms more than 48 hours after admissions
in patients with no evidence of infection at the time of
admissions.
●Aspiration Pneumonia
Refers to the pulmonary sequences resulting from entry of
endogenous or exogenous substances into the lower airway.

●Ventilator-associated pneumonia is a lung infection that

develops in a person who is on a ventilator. An infection may
occur if germs enter through the tube and get into the patient’s
lungs.
Who is most at risk of getting pneumonia?
You’re at an increased risk of pneumonia if you:
• Are over the age of 65 and or under the age of 2.
• Are living with a neurological condition that makes
swallowing difficult and stroke.
• Are in the hospital or at a long-term care facility.
• Smoke.
• Are pregnant.
• Have a weakened immune system if you’re on
chemotherapy, are an organ transplant recipient, living with
HIV/AIDS or are taking immunosuppressants medications
• Individuals with particular chronic medical conditions, such as
cystic fibrosis, asthma, COPD, diabetes mellitus, or
cardiovascular disease, kidney disease and liver disease.

• Individuals who have latterly had a respiratory infection, such

as a cold or the flu

• Individuals who have been exhibited to lung irritants, like

pollution, fumes.

• Mechanical ventilation/ breathing machines

What is the prevention and control of pneumonia?
Pneumonia can be prevented by;
• Good hygiene,
• Avoid exposure to people who are ill.
• Adopt healthy habits like exercising.
• Keep a cold from turning into pneumonia.
• Adequate nutrition to keep immune system strong.
• Immunization of Pneumococcal vaccines for all children younger
than 5 years old, and all adults 19 to 65 and older will need two
pneumococcal shots: the pneumococcal conjugate vaccine
(PCV13) and the pneumococcal polysaccharide vaccine (PPSV23).
Diagnostic procedure
• Chest X-ray shows presence/extent of pulmonary disease, typically consolidation.
• Gram stain and culture and sensitivity test of sputum may indicate offending
organism.
• Blood culture detects bacteremia ( bloodstream invasion ) occuring with bacterial
pneumonia.
• Pulse oximetry to measure the oxygen level in your blood.
• CT scan of the chest to get a better view of the lungs and look for abscesses or
other complications.
• Bronchoscopy, a procedure used to look into the lungs' airways. If you are
hospitalized and your treatment is not working well, doctors may want to see
whether something else is affecting your airways, such as a blockage.
III. History of the Patient
• A 33-year-old white female presents after admission to
the general medical/surgical hospital ward with a chief
complaint of shortness of breath on exertion. She reports
that she was seen for similar symptoms previously at her
primary care physician’s office six months ago. At that
time, she was diagnosed with acute bronchitis and treated
with bronchodilators, empiric antibiotics, and a short
course oral steroid taper. This management did not
improve her symptoms, and she has gradually worsened
over six months. She reports a 20-pound (9 kg)
intentional weight loss over the past year.
• She denies camping, spelunking, or hunting
activities. She denies any sick contacts. A brief
review of systems is negative for fever, night
sweats, palpitations, chest pain, nausea, vomiting,
diarrhea, constipation, abdominal pain, neural
sensation changes, muscular changes, and
increased bruising or bleeding. She admits a
cough, shortness of breath, and shortness of
breath on exertion.
IV. History of presenting Complains

A chief complaint of shortness of breath on exertion

after coughing.
V. System Review

A brief review of systems is negative for fever,

night sweats, palpitations, chest pain, nausea,
vomiting, diarrhea, constipation, abdominal
pain, neural sensation changes, muscular
changes, and increased bruising or bleeding.
She admits a cough, shortness of breath, and
shortness of breath on exertion.
VI. Past Medical History

• Hypertension

VII. Past Surgical History

• Cholecystectomy
VIII. Drug History

Lisinopril 10 mg by mouth every day.

IX. Family History

No family history.
X. Personal History

A 33-year-old white female, married in a

monogamous relationship and has three
children aged 15 months to 5 years. She is
employed in a cookie bakery. She has two pet
doves. No known medicine, food, or
environmental allergies.
XI. Travel History

She traveled to Mexico for a one-week

vacation one year ago.
XII. Social History

• Her tobacco use is 33 pack-years; however, she

quit smoking shortly prior to the onset of symptoms,
six months ago. She denies alcohol and illicit drug
use. She is in a married, monogamous relationship
and has three children aged 15 months to 5 years.
She is employed in a cookie bakery. She has two
pet doves. She traveled to Mexico for a one-week
vacation one year ago.
XIII. Examination
• Vitals: Temperature, 97.8 F; heart rate 88; respiratory rate, 22;
blood pressure 130/86; body mass index, 28
• General: She is well appearing but anxious, a pleasant female
lying on a hospital stretcher. She is conversing freely, with
respiratory distress causing her to stop mid-sentence.
• Respiratory: She has diffuse rales and mild wheezing; tachypneic.
• Cardiovascular: She has a regular rate and rhythm with no
murmurs, rubs, or gallops.
• Gastrointestinal: Bowel sounds X4. No bruits or pulsatile mass.
General: She is well appearing but anxious, a
pleasant female lying on a hospital stretcher. She is
conversing freely, with respiratory distress causing
her to stop mid-sentence.

Respiratory: She has diffuse rales and mild

wheezing; tachypneic.

Cardiovascular: She has a regular rate and rhythm

with no murmurs, rubs, or gallops.
Gastrointestinal: Bowel sounds X4. No bruits or pulsatile
mass.

Laboratory Studies: Initial work-up from the emergency

department revealed pancytopenia with a platelet count of
74,000 per mm3; hemoglobin, 8.3 g per and mild
transaminase elevation, AST 90 and ALT 112. Blood cultures
were drawn and currently negative for bacterial growth or
Gram staining.
Chest X-ray
Impression: Mild interstitial pneumonitis
Confirmatory Evaluation
On finding pulmonary consolidation on the CT of the chest, a
pulmonary consultation was obtained. Further history was
taken, which revealed that she has two pet doves. As this
was her third day of broad-spectrum antibiotics for a bacterial
infection and she was not getting better, it was decided to
perform diagnostic bronchoscopy of the lungs with
bronchoalveolar lavage to look for any atypical or rare
infections and to rule out malignancy.
Bronchoalveolar lavage returned with a fluid that was cloudy
and muddy in appearance. There was no bleeding. Cytology
showed Histoplasma capsulatum.

Diagnosis
Based on the bronchoscopic findings, a diagnosis of acute
pulmonary histoplasmosis in an immunocompetent patient
was made.
XIV. Phathophysiology
XV. Drug Study
XVI. NCP
Subjective: OBJECTIVES INTERVENTION RATIONALE EVALUATION
"I'm having a Objectives Independent For verify the oxygen level Patient dispaly
difficulty of After 8 hours of nursing •Assess and monitor the of patient in respiratory
interventions the patient ABG by pulse oximetry, distress if there is any improved
breathing when I
cough" as
will:
• Patient will demonstrate
skin color, mental status,
heart rhythm, body
improvement of the O2 ventilation and
saturation
verbalized by the improved ventilation and temperature and mucous •An effective way to adequate
patient.
oxygenation of tissues by
ABGs within the patient’s
discharge
•Provide supplemental
promote fluid replacement, oxygenation of
help maintaining
Objective: acceptable range and fluids such as IV, electrolyte and blood sugar tissues and
Productive cough absence of symptoms of
respiratory distress.
humidified oxygen, and
room humidification.
levels, increasing cardiac arterial blood
output and improve organ
Adventitious breath •Administer medications as perfusion. gases within
sounds; mild • Patient will maintain indicated, for example •It is important for normal range and
wheezing and rales optimal gas exchange and mucolytics, controlling chronic
demonstrate behaviors to bronchodilators, antibiotics conditions, treating decrease
Tachypnea
Dyspnea
achieve airway clearance. and analgesics.
•Elevate head and
temporary conditions, and symptoms of
overall long-term health
Vitals: • Patient will encourage frequent and well-being. respiratory
Temperature, 97.8 F/
display/maintain a patent
airway with breath sounds
position changes for
effective breathing and
•To promote physiological distress.
and psychological ease of
36.5°C; clearing; absence of coughing. maximal inpiration
Heart rate 88 dyspnea, cyanosis, as •For management of
evidenced by keeping a Collaborative underlying pulmonary
Respiratory rate, 22 patent airway and •Administer supplemental condition, respiratory
Blood pressure effectively clearing oxygen therapy as distress and cyanosis
130/86 secretions. indicated
XVII. Immediate goals / Long term goals

The goals of treatment are to cure the infection and prevent

complications. It is important to follow your treatment plan
carefully until you are fully recovered even though you will
probably start to feel better in a couple of days. If you stop,
you risk having the infection come back, and you increase
the chances that the germs will be resistant to treatment in
the future.
Most people can manage their symptoms such as fever and cough at home by
following these steps:
• Control your fever with aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs,
such as ibuprofen or naproxen), or acetaminophen.
• Drink plenty of fluids to help loosen secretions and bring up phlegm.
• Do not take cough medicines without first talking to your doctor.
• Drink warm beverages, take steamy baths and use a humidifier to help open
your airways and ease your breathing.
• Eat adequate nutritious food to boost the immune system.
• Stay away from smoke, environmental pollutions and chemical and fumes to
let your lungs heal.
• Get lots of rest.Adequate rest is important to maintain progress toward full
recovery and to avoid relapse.
• Engage in activities like exercising to strengthen your chest muscles.
• Improve your breathing by applying breathing techniques to efficiently help in
pulmonary rehabilitation.
XVIII. Prognosis

• If not treated appropriately and in a timely fashion,

the disease can be fatal, and complications will
arise, such as recurrent pneumonia leading to
respiratory failure, superior vena cava syndrome,
fibrosing mediastinitis, pulmonary vessel
obstruction leading to pulmonary hypertension and
right-sided heart failure, and progressive fibrosis of
lymph nodes.
Acute pulmonary histoplasmosis usually has a good
outcome on symptomatic therapy alone, with 90% of
patients being asymptomatic. Disseminated
histoplasmosis, if untreated, results in death within 2
to 24 months. Overall, there is a relapse rate of 50%
in acute disseminated histoplasmosis. In chronic
treatment, however, this relapse rate decreases to
10% to 20%. Death is imminent without treatment.